Healthcare Provider Details

I. General information

NPI: 1619479037
Provider Name (Legal Business Name): JENNIFER MORRIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 WASHINGTON AVE
EVANSVILLE IN
47715-4812
US

IV. Provider business mailing address

5000 WASHINGTON AVE
EVANSVILLE IN
47715-4812
US

V. Phone/Fax

Practice location:
  • Phone: 812-647-2685
  • Fax: 812-473-0114
Mailing address:
  • Phone: 812-647-2685
  • Fax: 812-473-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26025850A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019044
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011026620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: